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When You Need a Clinical Pathway

By By Heather Maloney BIDMC Correspondent

Published On: Apr 04 2013 05:19:23 PM EDT

Having a surgical procedure is nerve-wracking at best, but doctors at Beth Israel Deaconess Medical Center in Boston have adopted a method for making surgery less stressful for the patient while reducing costs and improving outcomes.

Called a Clinical Pathway, it is literally a checklist posted next to the patient’s hospital bed that serves as a roadmap for both the caregivers and the patient throughout their recovery. It lists everything from what tests a patient can expect before surgery, to how soon he or she should be able to sit in a chair, to when an IV will be removed.

It sounds simple, but it’s having a big impact. “Clinical pathways have emerged not just here but across the country because they maximize quality in patient outcomes,” says Dr. Mark Callery, Chief of the Division of General Surgery at BIDMC. “Clinical pathways provide tangible ways to reduce the length of hospital stays and reduce costs.”

Dr. Callery first introduced clinical pathways at BIDMC in 2004, for patients having pancreatic surgery. “There is still a lot of variation in medical practices, which results in increasing medical costs,” he says. “With a clinical pathway, everyone is on the same page—nurses, doctors and the patient.”

The results have been impressive. Since the clinical pathway was implemented for pancreatic surgery in 2004, the hospital has these seen patients’ hospital stays reduced by over a full day while achieving a cost savings of 17 percent.

The pathways also provide doctors with a way to identify areas that need improvement. For example, when Dr. Callery and his colleagues looked at pancreatic surgery patients who weren’t achieving optimal pathway results, they realized that most of these patients were over 75. They reviewed each patient’s case to see where they had deviated from the clinical pathway, and pinpointed areas for improvement. Now, a specialty geriatrician meets with each patient before their operation and advises doctors on medication selection and issues relating to advanced age.

Dr. Callery also believes that Clinical Pathways contribute dramatically to patient education and patient satisfaction. “Now, when a patient comes to see me for an operation, they leave with information that spells out what they can expect each day that they’re in the hospital, in layman’s terms,” he says. “They know what they can expect of us, and what we expect of them.”

Patient response has been extremely positive, according to Dr. Callery. “Being operated on is stressful,” he says. “The Clinical Pathway reduces that to some degree. They feel more a part of the team, when in fact they’re the most important member of the team.”

BIDMC has implemented Clinical Pathways in more than 30 surgical specialties, and the program continues to expand.

Bottom line, it’s all about what’s best for the patient, Dr. Callery says. “We have a team approach here to make sure that a stressful situation is as easy as possible for the patient.”

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